Patient Education

How to Use Your Inhaler

Using a Metered Dose Inhaler

Cómo Usar un Inhalador de Dosis Fija

Using a Metered Dose Inhaler with a Spacer

Cómo Usar un Inhalador de Dosis Fija con Espaciador

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Mucus Clearance Regimens

Many people with respiratory diseases COPD and Cystic Fibrosis have to deal with extra phlegm and congestion in their lungs and airways. It’s an unfortunate symptom that can be difficult to manage, especially during periods of illness and exacerbations.

The reason for the excess mucus is inflammation in the respiratory tract caused by the disease. This kicks your mucus membranes into overdrive in an attempt to lubricate and soothe the lungs and airways, but it often leads to way too much extra mucus that is difficult to clear out.

Another cause of congestion in people with COPD is damaged lung tissue, which is not nearly as good at moving mucus up and out of your chest as healthy lungs are. When you pair that with decreased lung function and restricted airways, it can be nearly impossible to force out phlegm without some extra help.

For someone with COPD, excess mucus is particularly difficult to deal with because of common symptoms like chest tightness and airway restriction. When there’s extra mucus and phlegm hanging around in the respiratory tract, it is especially difficult and uncomfortable for someone with COPD to breathe and cough controllably.

Fortunately, there are many different techniques and medications that can clear up congestion for people with a respiratory disease.

Drink Plenty of Water

If you don’t drink enough fluids throughout the day your mucus gets thicker and more difficult to drain or expel. Thick, sticky mucus is difficult to cough up and tends to get stuck in your airways, making it more difficult to breathe.

That’s why it’s especially important for people with COPD to drink enough water. Keeping your body hydrated helps keep your mucus thin and fluid, which makes it much easier to clear out of your airways.

Controlled Deep Coughing

Coughing is the body’s natural, instinctual way to get rid of chest congestion, and it’s often surprisingly effective. When your COPD causes your airways to get clogged up with mucus, coughing is one of the first things you should try.

However, uncontrolled, frantic coughing is usually not the best way to clear mucus from your airways. That’s why doctors have developed coughing techniques to help you control your coughing and make it even more effective, especially for COPD patients who have difficulty producing strong, productive coughs.

A “controlled deep cough” is a simple, heavy cough that you force from deep in your lungs. Start by sitting in a comfortable place, leaning forward slightly, taking a long, deep breath in.

Next, hold your breath for just a few seconds and then use your abdominal muscles to forcefully push the air out through your mouth. You can even cross your arms over your stomach and use gentle pressure on your abdomen to help expel the breath.

While practicing this technique, you might get the urge to clear your throat or begin coughing reflexively, but do your best to ignore the impulse. Instead, take a few normal breaths, and then try another deep, controlled cough.

This method is more comfortable, and more effective, than a hacking, uncontrolled cough.

Controlled Huff Coughing

Another form of controlled coughing, huff coughing, is a gentle and effective way to clear phlegm out of your airways. It’s also known as the forced expiration technique and it works because it keeps the throat open and effectively moves mucus out of the lungs.

There are 5 simple steps to performing a huff cough:

Start by sitting upright in a comfortable seat and lift your chin slightly.

Empty your lungs by exhaling slowly and completely for several seconds.

Hold your breath for 2-3 seconds, then force the air out through your mouth in three rapid huffs, taking care to keep your throat open

Repeat the technique, but take a slightly smaller breath this time. You can repeat the huff coughing technique as needed, alternating between small and large breaths.

Successful huff coughing usually requires about 3-5 repetitions with at least 5-10 normal breaths in between. A respiratory therapist or doctor can help you perfect the proper huffing technique, and remember to stop huffing if you begin to feel pain or exhaustion.

Chest Percussions

Chest percussion is a type of chest physical therapy that essentially involves tapping or clapping on your chest with your hand. This physically loosens and breaks up mucus that is stuck in your airways, making it easier to cough up out of your lungs.

The proper technique is to sit while leaning back and use a cupped hand to deliver very firm, but gentle claps to the upper-left and upper-right part of your chest (in the space between your collarbone and nipple). You will want to start by tapping the left side of your chest for 2-3 minutes, and then repeat the percussions on the right side for another 2-3 minutes.

You should feel the mucus loosening in your chest as you perform the percussions and feel the urge to cough immediately after. Allow yourself to cough up as much mucus as you can in-between percussions until you’ve cleared all the excess phlegm from your chest.

Percussions should always be firm, but not painful, and done in a steady rhythm. Always make sure to position your hands in the correct place before performing any kind of percussion.

Do NOT perform percussions on any of these areas:

Avoid the stomach

Avoid the breastbone

Avoid the spine

Avoid the lower ribs and lower back (to prevent injuring organs)

Back Percussions

Back percussions usually require you to have a caregiver or respiratory therapist there to help out. They are very similar to chest percussions, but you lean forward and have someone else tap key spots on your back instead of your chest.

Start in a leaning-forward position, by holding a pillow to your chest and bending forward at the waist. Then have your therapist or caregiver tap gently but firmly on your back with a cupped hand, in the space right above your shoulder blade.

Tap for 2-3 minutes in that spot, then repeat again above your right shoulder blade. The mucus in your chest should loosen, allowing you to cough and expel it from your lungs.

Expectorants

Expectorants are common over-the-counter medications that help thin and loosen up mucus in your chest and make it easier to cough up. However, studies show that expectorants might not be as effective or useful for people who have COPD.

Expectorants seem to work best in patients who have chronic bronchitis, but even then the benefits aren’t particularly impressive. Make sure you talk to your doctor before taking expectorants to treat your COPD symptoms, and be aware that it might not work.

Some of the more common over the counter expectorants include Mucinex and Robitussin DM.

Mucolytics

Mucolytics are a type of oral medication used to treat COPD patients with thick mucus and difficulty expelling it from the respiratory tract’s Much like expectorants, mucolytics cause mucus to become thinner and easier to clear out of airways.

Unlike expectorants, which are usually taken as needed, mucolytics are usually taken daily to prevent symptoms. Mucolytics seem to be more effective than expectorants for patients with COPD, and can even prevent and treat exacerbations.

Some examples of mucolytic drugs often prescribed to patients with COPD:

Carbocisteine

Erdosteine

Mecysteine

Saline Nebulizer

Nebulizers are often used to dispense medication to patients with asthma and COPD, but the evidence is piling up that COPD patients can also benefit from using a nebulizer with a plain saline (salt water) solution.

Using a saline nebulizer is considered very safe, but you should still talk to your doctor first before trying any kind of new medical treatment. You also need to make sure you use a medically approved, hypertonic saline solution.

Positioning To Promote Drainage

Another form of chest physiotherapy, postural drainage, is about placing your body in different poses or positions to help mucus drain downward out of your lungs. The unique positions encourage different lobes, or sections, of your lung to drain out until you can cough up or spit out the phlegm.

Positional drainage is often much more effective when you use it in combination with chest percussions and vibrations. It works best if a caregiver or respiratory therapist helps by performing the vibrations while the patient relaxes in a postural drainage position and exhales slowly.

Here are a couple of common postural drainage positions (although there are still many others!):

Draining mucus from the back of the lungs: In this position, you lie on your stomach and place pillows under your hips (usually three pillows are recommended) to raise your lower back and a small pillow under your head for comfort. Place your arms above your head and breathe deep from your belly.

Draining mucus from the sides of your lungs: To drain the sides of your lungs, lie on one side and place a few pillows under your hip and a small pillow under your head. Stay in this position for 5 or 10 minutes, breathing deep from your belly for the duration.

The gravity along with the percussions and vibrations should effectively move the mucus out of your lungs, into your larger airways, and to your mouth where you can expel the excess sputum.

Active Cycle of Breathing Technique

The Active Cycle of Breathing Technique, or ACBT, is a three-step method for clearing mucus from your airways that is often recommended to patients with COPD. Like some of the other techniques we’ve discussed so far, ACBT includes coughing techniques, but combines them with chest and breathing exercises for maximum effect.

Follow these three steps to perform the Active Cycle of Breathing Technique:

Step 1: Relaxed, Controlled Breathing

Breathing slowly and steadily can help relax your airways and make it easier to expel mucus. Even though it can be difficult when you are congested, you want to try not to wheeze or breathe heavily before attempting to cough up mucus with this method.

Start by sitting up in a comfortable position and relaxing your chest, shoulders, and abdominal muscles. Breathe gentle, regular breaths by inhaling through your nose and exhaling from your mouth.

You want to breathe very gently with your lower chest so your upper chest can relax. You should feel your stomach rise and fall as you breathe, and it can help to lay one of your hands on your stomach to feel your abdomen expand as you take each breath.

Practice this controlled, gentle breathing for at least six breaths before moving on the next step.

Step 2: Chest Expansion Exercises

Now that you’ve relaxed your chest and practiced even breathing, it’s time to loosen up and expand your chest. Doing this is as simple as taking in a large, deep breath.

Once you’ve filled your lungs up with air, hold it in for a moment or two, and then exhale gently. Don’t force the air out.

Step 3: Controlled Huff Coughing

Now that you’ve used breathing and chest exercises to relax and expand the muscles in your chest and around your lungs, it’s time to clear out the phlegm with huff coughing. This time, you do want to use forced expiration to get the mucus out of your airways.

Continue controlled huff coughing until you’ve forced all of the excess mucus out of your lungs and chest. Refer to the section near the beginning on huff coughing for a more detailed guide on how to use the huff cough technique.

All About Your CPAP Machine

What is it?

The CPAP machine is basically a small box which has a motorized fan inside. This fan very quietly draws air from the room, gently pressurizes it, then delivers it at a setting specific to your needs.

The air intake section of the CPAP machine has a filter on it to eliminate the intake of dust, smoke, or other impurities in the air. This filter can be replaced as necessary.

Another key part of the CPAP machine is the humidification chamber built into the box. This is where water is warmed to humidify the pressurized air before it is delivered. Warm, moist air soothes your nasal and upper airway passages and helps prevent swelling and discomfort that can sometimes occur while using the therapy. Although using humidification is optional, it brings relief for the majority of patients using CPAP therapy who live in dry or arid climates or who wake up with a dry mouth, nasal passages, or throat. The humidification chamber is pretty easy to keep clean and should last the lifetime of the machine itself.

Attached to the CPAP machine is a hose which connects the box to the mask. This flexible, lightweight tubing is also typically heated to reduce any condensation that might collect inside it while the humidifier is in use. The hose is long enough—around 6 feet—to give you full movement during sleep. Hoses can wear out over time and should be replaced as necessary.

That leaves the CPAP mask. It is often said that the success of CPAP therapy often rests on how comfortable and well fitting the mask is. CPAP masks come in a variety of shapes and sizes to suit the vast array of facial landscapes. Masks wear out over time and should be replaced on a regular schedule.

CPAP machines, finally, are fairly compact and can easily fit on a standard nightstand. They are pretty easy to keep clean and, with regular maintenance and care, should last you a long time.

How Does CPAP Work?

People who have sleep apnea have problems with keeping the airway open for normal breathing as they sleep. Mostly commonly, the soft tissue in the throat and oral cavity (the tonsils or tongue, for instance) relaxes and/or collapses, closing off the space needed for air to move through the nose and into the lungs. This leads to pauses in breathing that can happen consistently enough, and long enough, to deprive the bloodstream of the oxygen it needs to deliver to all the organs.

The brain senses this drop in blood oxygen and forces an awakening. However, some people can experience more than 100 of these pauses and awakenings per hour for most of the night! It’s no wonder why some people with severe sleep apnea feel so tired all the time.

If this interrupted pattern of breathing is left untreated, it can create long-term health problems for the sufferer.

CPAP was created to help keep these pauses from happening. The machine, by way of the tubing and mask, delivers a stream of pressurized air as a kind of “pneumatic splint” to help prevent the collapses that are characteristic of obstructive sleep apnea. By helping to keep the airway firm and open, the pressurized air provides the support necessary for the user to breathe freely and without obstructions.

Some people, when they start CPAP therapy, discover almost right away the relief of sleeping all night long without waking up once. Others may take their time to adjust, which is more typical.

One thing remains true for both types of users: the more they use it, the easier CPAP becomes to use, and over time, they find it a welcome luxury to use their CPAP machine, as it returns to them the good nights of sleep they had been missing out on for years.

Getting Setup With a CPAP Machine

In order to start CPAP therapy, you first need to be diagnosed with sleep apnea by an accredited sleep physician. This involves a night of testing at the sleep lab.

Following diagnosis, it may be necessary for you to visit the lab another night to try out your CPAP therapy, to determine the air pressure setting that best benefits your condition, and to help you find a good-fitting, comfortable mask.

After these goals are reached, youwill meet with a durable medical equipment (DME) specialist who will set you up with your entire CPAP kit: the machine, the hose, the mask. They will give you all the instructions you need for using it and answer any questions or concerns you have, not only on the day you receive the CPAP machine, but in the weeks that follow as you adjust to using it.

The main goal is to use the CPAP machine every night for as long as possible in order to enjoy the benefits of quality sleep and good oxygen levels in the blood. Not only will you feel better, but regular CPAP use will prevent a lot of chronic illnesses from developing (such as high blood pressure, diabetes, or cardiovascular disease) or at least relieve the symptoms of the ones you may already have. You may also enjoy improvements in energy, focus, and overall mood that come with restoring balance to your whole body.